Adoption of costing systems by U.S. hospitals

This article re-examines the use of costing information in hospitals. While previous research reports that hospitals are increasingly adopting costing methodologies, survey results indicate that costing systems and cost methodologies have not been widely implemented. A telephone survey of 94 hospital executives revealed only 26 percent routinely collect procedure-level costs and only 12 percent apply basic costing techniques described in prior health care management literature. It appears that despite cost accounting's benefits, immediate cost-control problems are answered with short-term, focused cost-cutting solutions. While these short-term measures allow hospitals to survive in the current environment, health care reform and other pressures to control revenue growth will make sophisticated cost management a necessity for hospitals in the near future.     

A multidisciplinary team approach to day hospital patient care

A review of practice in a mental health day hospital led to a multidisciplinary quality group being established. Outlines changes implemented leading to service improvements and increases in patient and staff satisfaction.     

How consumers view chiropractic advertising

Chiropractic, as a medical profession, is finally receiving acceptance from the American Medical Association (AMA) and other medical groups. However, what do consumers think about chiropractors and how do they respond to the advertising efforts of chiropractors? This paper presents the findings of a survey concerning consumers' opinions of advertising by chiropractors. Although the opinions of the respondents were mixed, an analysis of the results of the survey suggests important implications for chiropractors and other medical practitioners who wish to use advertising media in marketing their services.     

Functional ability assessment: guidelines for the workplace

Short- and long-term disability certification is required in all Western countries for extended time away from work. The Americans With Disabilities Act mandates that medical providers use rational thought and justifiable criteria when evaluating an employee's "fitness for duty". In order to facilitate employment/disability decisions, physicians must now serve as an advisor to the employer. Both the employer and the physician are legally obligated to carefully justify any recommendations for placement or exclusion from the workplace. We propose a uniform methodology that both physicians and employers could use together to determine the performance capability of an individual with a temporary or permanent impairment or disability in terms of essential job functions as defined under the Americans With Disabilities Act.     

The effect of microcolony size, at time of irradiation, on colony forming ability

PURPOSE: To investigate the effect of irradiating microcolonies of various sizes on their subsequent ability to form colonies. MATERIALS AND METHODS: The location of individual HPV-G cells in tissue culture flasks was recorded using computerized microscopy. This allowed the cells' positions to be continually revisited, which enabled manual sizing of individual microcolonies both at the time of irradiation (between 0-5 Gy) and following an incubation period during which the microcolonies were assessed for cologenic survival. RESULTS: The experiments indicate that when irradiated as microcolonies, cells have plating efficiencies (PE) that are lower than expected when compared with the prediction from the PE values of cells irradiated individually. CONCLUSION: These data support the conclusions of Mothersill and Seymour (1997b) which challenge the concept of independent survival of certain types of cells following irradiation. The results indicate that interactions between cells can occur even in small aggregates.     

Inducible genetic suppression of neuronal excitability.

Graded, reversible suppression of neuronal excitability represents a logical goal of therapy for epilepsy and intractable pain. To achieve such suppression, we have developed the means to transfer "electrical silencing" genes into neurons with sensitive control of transgene expression. An ecdysone-inducible promoter drives the expression of inwardly rectifying potassium channels in polycistronic adenoviral vectors. Infection of superior cervical ganglion neurons did not affect normal electrical activity but suppressed excitability after the induction of gene expression. These experiments demonstrate the feasibility of controlled ion channel expression after somatic gene transfer into neurons and serve as the prototype for a novel generalizable approach to modulate excitability.     

Influence of endothelins and sarafotoxin 6c and L-NAME on renal vasoconstriction in the anaesthetized rat.

1. An investigation was performed in pentobarbitone anaesthetized rats to compare the renal vasoconstrictor actions of endothelin-1 (ET-1), endothelin-3 (ET-3) and sarafotoxin 6c and their dependency on NO production. 2. Intra-renal arterial infusion of ET-1 and ET-3, from 1 - 1000 ng had no effect on blood pressure, but reduced renal blood flow maximally by 82 and 81% with EC50 values of 510+/-18 and 1113+/-17 ng, respectively and correspondingly increased renal vascular resistance and decreased conductance. 3. Direct renal arterial administration of sarafotoxin 6c was without effect on blood pressure but caused a maximum reduction in renal blood flow of 56% at 300 ng and had an EC50 of 86+/-4 ng. 4. Administration of the selective ETA receptor antagonist FR139317 at 0.3 and 1.0 mg kg-1 had no effect on basal levels of blood pressure, renal vascular resistance or renal blood flow. The lower dose of FR139317 had no effect on the ET-1 dose-response curve for renal blood flow while at 1.0 mg kg-1, FR139317 reduced the EC50 to 363+/-32 ng (P<0.05). 5. Infusion of L-NAME, 10 microg kg-1 min-1 increased blood pressure by approximately 15%, increased renal vascular resistance and decreased renal blood flow by some 40%. The EC50 values for renal blood flow were reduced to 358+/-68 ng (P<0.05) for ET-1, 638+/-69 ng (P<0.05) for ET-3 and 55+/-10 ng (P<0.01) for sarafotoxin 6c. The maximal reduction in renal blood flow induced by sarafotoxin 6c was raised (P<0.01) from 56% to approximately 100% and renal vascular resistance increased when NO production was blocked. 6. These results showed that the vasoconstrictor actions of ET-1 and ET-3 on resistance vessels controlling renal blood flow are mediated via ETB rather than ETA receptors. Moreover, both ET-1 and ET-3 dependent vasoconstrictions are slightly attenuated by concomitant NO production. By contrast, sarafotoxin 6c appears much more potent at the renal resistance vasculature and is much more powerfully modulated by NO.